Thursday, February 26, 2015
Thursday, November 20, 2014
Five days after I was raped I flew to Boston. The security lines were endless, claustrophobic, and humming with the restless panic of herds before a lightning storm. I took off my shoes and my belt, and walked through the metal detector. A shrill alarm went off, and a security guard shoved me forward towards a female guard for additional screening. She slid her arm roughly up the inside of my thigh and I jerked away. She grabbed me by the arm and asked me if I had a problem. Did I? She asked. She sneered down at me. Did I? Did I have some kind of problem? Did she need to get a supervisor to address my complaint or report my uncooperative behavior?
This was in 2001, when travelers were so cowed by the need for security measures in airports we would submit to any indignity without complaint. To be uncooperative was to be suspicious, and to arouse suspicion was terrifying.
No, I said. Of course not.
In 2004, I was traveling across Europe with some friends. We wandered out of our car looking for a covert place to sneak an illicit cigarette. At the far end of the train was a car that at first glance seemed unoccupied, but which was soon revealed to contain two male backpackers lying across two separate rows of seats, studiously avoiding eye contact with one another and masturbating furiously.
My friend and I stood there, aghast. They looked at us, looked us up and down. They didn't stop. One of them said, "Hey, you can't smoke in here."
My intention in relating the above anecdotes is not to advocate that we be more assertive with the TSA, or that more people should be allowed to smoke on trains. I would like to be clear that neither of these activities are healthy. But for me, almost fifteen years later, neither are airports and neither are trains. Airport security gives me the screaming jeebies. A bunch of angry people in uniforms usher you humorlessly into a grim little oubliette where you stand in a defenseless, ridiculous posture while an invisible robot smells your ass to see if you're carrying anthrax or incendiaries, and on the other side they give you the gropes to be sure that your underwire bra doesn't convert to a ground cannon. This gives me the pukes.
I don't want to do things that give me the pukes, but I sometimes have to. This is the same kind of dilemma we see evinced in all decisions that are made by agencies on our behalf to protect populations. Unilateral mandates, like seat belt laws, transportation security measures, and water fluoridation are things that we are subjected to, often in violation of our autonomous interests, because they are considered to be in the interest of greater good for the population. I can't disagree with this. I support vaccines, because I do not want to die bleeding out my eyes if there is any possible way to avoid this. And so by the same token, I support transportation security measures, because I want to feel safe when I travel.
Except I don't feel safe.
One of my favorite feminists wrote this incredible piece about a recent experience on a train in Scotland. She and another female traveler, after being harassed with insults that escalated to threats of violence and rape, were advised that they should have changed seats or complained to a (non-existent) employee. No one intervened.
For our safety, we are advised not to leave our bags unattended, because they will be subject to seizure and search. We are advised not to lock our bags, because this will make it more difficult for the bags to be inspected, for our safety. We are advised to hold still, with our arms above our heads, while complete strangers run their hands over our breasts and between our legs, for our safety. And we agree to these compromises of our autonomy in the interest of contributing to the overall safety of our environment.
But who bears the ultimate responsibility for our safety when we travel? Most seat pockets contain safety information, and some variation on the assurance that our safety is the primary concern of <insert business here>. But whose safety? And what are we being protected from?
A few years ago, I sat on a plane next to an aggressive drunk who spent the entire four hour flight relentlessly supplying me with details about his penis, and some limited perseverations on the theme of his ex-wife (a "Real cunt"). He leaned over my seat, slurring broken heartedly about his vasectomy. He squeezed my purse, mistakenly believing it was my thigh. He asked intrusive questions.
"Excuse me," I said politely. You have to be polite, because if you are not, you are a bitch. You are not firm, or severe, or forbidding. You are not assertive or clear. You are a real cunt, and this is inadvisable, because nothing is going to piss this guy off like a real cunt. We all know not to provoke predators. And so, smilingly, I said, "Would you mind giving me a little more space? I'm feeling a little claustrophobic."
He said, "You don't need to be such a bitch about it."
For the rest of the flight, he monopolized the armrest. He pretended not to hear me when I asked to use the bathroom, forcing me to squeeze past his legs and lap. He slumped against me while his hand scrabbled against the seat, searching blindly for my leg. He sat too close.
Perhaps I should have asked to move. Perhaps I should have asked a flight attendant for help. But the flight was full. The intervention of the flight attendant would only have escalated the situation. And so I sat there, for hours, while this man menaced me. I did not feel safe.
When we participate in the security theater, we are doing it with the understanding that we can all contribute to making travel safer and more comfortable for everyone. But the issues we prioritize give us a lot of insight into our values, and into whose priorities are being represented. So whose security are we taking steps to protect? Should the fact that you walked through a metal detector or elected not to bring a rifle onto the train represent the extent of your responsibility for the safe environment of others? Or do we owe it to the people around us to step in and intervene when people become the victims of threatening behavior? How far are the businesses we patronize responsible for the safety of their customers and their environs? Is there a special TSA machine that can detect assholes, sexual predators, and misogynists?
We are a world preoccupied with the security of our travels. It seems so odd that we would overlook a fundamental requisite for the personal safety of so many.
Friday, August 2, 2013
Wednesday, May 1, 2013
Also I got married, but don't be alarmed. This will never be a blog about a wedding. Suffice it to say that there is no limit to the shit that you can spend your money on when you are planning a wedding, and that NO ONE has a sense of humor when it comes to matching the napkins to the floor or finding a plant that people aren't allergic to to staple to a tux jacket that you may or may not recoup a deposit from. Moreover, there is so much useless bullshit that is suddenly a dramatic imperative, like somehow you won't be really married without it.
But I digress. My point is, that somehow, by hook or by crook, I had to get some money. And as an ethicist, I am morally prohibited from hooking, because that is against the law in the state of Washington.
Thankfully, there seem to be an innumerable cadre of jackasses desperate to give me a paltry sum in exchange for a modicum of effort on my part. While I formulate for your edification and entertainment pending posts about genetically modified foods, patenting DNA, water fluoridation and the consumption of neurotoxins, please occupy yourself with the following exchange. Also if you have any money you want to send me start stuffing it into an envelope because SHIT IS REAL IN 2013.
Sent: 4/9/2013 11:41 AM
Sent: 4/9/2013 12:06 PM
Subject: RE: Invitation to Contribute to Pain Medicine Board Prep Course
1) Just what the hell are YOU looking at?
2) Do you want a knuckle sandwich?
3) Does this hurt?
4) What's your problem, pal?
5) How about THAT? DOES THAT HURT, TOUGH GUY?
Thank you for your interest in our progressive method of pain management. The large body of evidence supporting experiential learning suggests that in order to effectively manage pain, the pain must first exist. That should learn them real good. Please feel free to contact me for further input.
My very best,
(the "Doctor" is silent.)
Tuesday, April 3, 2012
"That there's the black guy's house."
"Look at all those emergency lights. What do you want to bet there's a golf cart underneath all that."
"you can really tell the age of a community when you got 35 thousand places that do dental work and about three million urologists."
"look at that bastard all sitting out there in his wheelchair with a margarita."
Tuesday, February 14, 2012
The internet horrifies me and I can barely use a toaster.
But I started small. I started by talking about the weather.
I liked some things on facebook.
Then I drank too much and upvoted everyone on Reddit, which is probably an internet faux pas but how the hell would I know since they didn't actually make me sign a waiver.
Then I took the plunge and REVIEWED MY CAT.
and I got retweeted, which I think is like getting a really unimpressive award but I got unreasonably excited about it because the internet is like a foreign country in which I can only recognize the native language for "hello" and "fuck you."
In any event.
This seems like as good a time as any to admit that you can now follow me on twitter.
Thursday, January 19, 2012
One thing that I have actually committed to doing is to write more about issues that matter to me. It’s super easy for me to craft a post for the sole purpose of referring to Daniel Quinn as a total asshole, but not so easy for me to deliberately confront my own defensible truths. And so in my first post this year, I want to write about something that I think is really important to a lot of people, and that’s a frank discussion of the doctrine of fear surrounding vaccinations.
I have been flippantly censorious of the vaccine phobia more than once on this blog, and I unequivocally stand by my position that exposure to Jenny McCarthy should result in a quarantine. I will, admit, however, that statements like that don’t really serve to educate or conciliate people who don’t already agree with me, and I’m not sure that it’s not an irresponsible application of my education in health sciences to alienate people who have legitimate curiosities about the dangers of vaccines.
Historically, the implementation of all public health interventions has been characterized by a conflict between personal autonomy and public benefit. This poses a formidable dilemma. The ethical execution of public health should always take into account the fact that implementing public health programs creates a palpable tension between individual autonomy and perceived population benefit. While it is, of course, requisite that there always be an explicit respect for persons inherent in every public health action, there are instances in which the overarching principle of beneficence takes precedent. Those instances must be carefully analyzed and objectively evaluated, and they are rare and far between. Newborn screening programs, childhood vaccinations and water fluoridation are three of relatively few such programs ever implemented in the United States. The conflict is not one that policy makers underrate; it’s difficult to minimize the impact of what might be characterized as a transgression on personal freedoms in a society as committed to individual liberty as ours.
This is especially difficult when policy dictates that we impose a measure in the name of public health that is perceived as dangerous, and potentially harmful. Vaccinating children is such a measure, and the controversy generated by state laws mandating these vaccinations has been prodigious.
It is really easy for those of us in public health to dismiss dissenters as lunatics and morons. It is really, really easy to wax lyrical about the fatuity of this movement, to make fun of the maniacs who commit violations of federal laws to expose their children to infected candy mailed to them by a stranger from the internet, OH MY GOD.
But it is ultimately not very helpful.
It is irresponsible and harmful to dismiss this population as imbecilic or insane. I realize that it’s simpler, and I’ve been guilty of it myself, but in many ways that behavior reduces you to the practice of blaming the victim. The central tenet of public health is not that we show respect only for the people who agree with us. Public health requires a necessary element of education, because you are not dealing with a horde of scientific practitioners, you are dealing with the public. IT SAYS SO RIGHT IN THE FUCKING NAME. Public health. And public opinion matters, especially in a case like this.
So in my opinion, it is far more efficacious to acknowledge that these fears exist, and that the potential impact of these fears on the overall health of our population is significant. And that, whether or not we believe wholeheartedly that these fears are ignorant, or wrongheaded, or pernicious, we do not fulfill our duty to one another by deriding those beliefs. So here are some facts.
Vaccines work by providing the body with an ersatz version of the disease in question, and allowing the body an opportunity to mount a response to the fascimile, without exposing the individual to the whole package. Diseases are neutralized for vaccines in different ways. Often, the infectious agent is killed by heat or other chemicals. sometimes, the virus' ability to reproduce is destroyed, meaning that the disease cannot mulitply in the body. For some diseases, like hepatitus, it is enough to simply expose the immune system to an associated protein. Once a virus has been killed or neutralized, it cannot hurt you. The illness that people feel after receiving a vaccine is not the virus contained in the vaccine, it is your immune system responding to a foreign agent, memorizing it, and mounting a response designed to remove it. Once your immune system has recognized something as harmful, it can be destroyed. And given another exposure, your body will simply annihilate the intruder without the necessity of a full scale immune response. This is why people only get the chicken pox once - your body won't be fooled twice by the same trick. Colds and influenzas are slightly different, since those viruses are always changing and adapting. This is why some people get a flu shot every year.
The truth is that vaccines are not always 100% safe. They contain some preservatives that look and sound alarming. They occasionally precipitate an immune system response that can be unpleasant. Other safety concerns have revolved around mercury and Thimerosal, which is a compound containing organomercury, historically used as a preservative in vaccines and other medications. Over the course of the last decade, safety concerns about the use of Thimerosal (also known as Merthioloate, the trade name of the compound developed by Eli Lilly) have prompted the FDA to phase out its use from vaccines given to children under six. That means that the Measles, Mumps and Rubella vaccine, traditionally given at 18 months, does NOT contain Thimerosal.
It is worth noting that all of the multiple trails testing the safety and efficacy of Thimerosal have suggested that the compound is safe for the controlled uses to which it is put. However, public opinion and preference has guided the evolution of policy on this issue; and the development of more acceptable compounds has made the substitution much easier.
One exceedingly harmful myth about vaccines is that the government requires them simply because the government is in business with big pharma. THAT IS FALSE.
Vaccines themselves reside in a nebulous legal category known as "Unavoidably Unsafe." This is a designation given to drugs that are deemed necessary for population health, but which cannot be designed to be entirely innocuous. This label means that there is a certain amount of risk inherent in the treatment, but that the benefits outweigh the harms so significantly that there can be no question about the propriety of administering it.
If a company were to be held responsible for every adverse side effect resulting from a drug, there would be an enormous economic disincentive to making that drug. This is why safety trials are necessary. If, however, the product is considered necessary, the companies that create these products are allowed a certain amount of indemnity from litigation, in order to assure that access to these necessary treatments is retained.
Products must meet very, very specific criteria in order to be considered "Unavoidably Unsafe." The product must be produced to the standard specifications, meaning that there must be no error or negligence in the actual production of the product that caused the damage. If a company were to make a mistake in a batch of vaccines, for instance, and accidentally add a bunch of rat poison, the product would not be considered "Unavoidably Unsafe," it would be considered "Shitty." Secondly, the marketers of the product must be transparent about the potential known risks. The product must, as discussed above, have a clinical utility that greatly overrides the potential for harm, and there must be no other alternative to the product available.
As it stands, we don't have a better alternative for vaccines. They can sometimes cause our immune systems distress. Care providers are honest about those potentials, and vaccines have proven to be so advantageous and beneficial that those risks have been deemed acceptable. And all of this would be ok, if it weren't for our 21st century witch hunt for the causes of Autism.
An additional truth is that the vaccine schedule is, in fact, kind of arbitrary. Vaccines are scheduled at 18 months because they will conform to the changes in a child's immune system as they acquire their own resistance, and so they will coincide with established wellness checkups. That is convenient, and in the consumer driven medical market that we have created for health care, convenience is king. It is also true that 18 months is the time that many symptoms of disorders on the autism spectrum become apparent. It’s understandable that this connection might be where we start to look for a causal relationship.
What it is imperative to remember is that correlation is not causation. A 1998 study published in the British Medical Journal, The Lancet, claimed to have demonstrated a causal link between vaccinations and the onset of traditional symptomology pathognomonic of autism. This study terrified people, and caused a widespread panic. Consequentially, many people refused to vaccinate their children, and the findings were widely publicized by the media. Over the subsequent decade, follow-up studies failed to replicate the results, all of the co-investigators of the study dissociated themselves from the paper, and in 2010, the Lancet itself withdrew the publication. What this means is that the information and the associations supported by the data collected in the study have proven to be spurious. As it turned out, the lead investigator was found to have fabricated those data, and was forced to acknowledge the fraud in ignominy. The twist here is that this retraction was not as widely publicized as were the initial study findings. The NIH and the WHO did not embark on an aggressive media campaign, trusting that every mom in the world had nothing better to do than refresh the lancet website daily researching ethics violations. Even I only do that when I’ve been drinking cooking wine and thinking bitter thoughts about Anthony Bourdain.
So what we’re left with is a significant proportion of the population that have been grievously misinformed by a primary source, which was subsequently interpreted and disseminated by innumerable other sources and inadequately refuted by organizations that should have made it a top priority. By then it was a little late; the damage was widespread, and the consequences are becoming apparent.
The concept of population health is in a way self-sustaining, in that we rely heavily on acquired or achieved immunity in others to protect ourselves. We call this “herd immunity,” and we base our assumption on the principle that diseases rely on susceptibility in their target organisms to spread. reducing the overall susceptibility in a population provides less opportunities for infection, thereby reducing the rate of incidence. When a large cadre of people fail to acquire immunity through vaccination, an infected agent’s ability to spread is greatly increased. Already in the United States we are seeing the consequences of the reluctance to vaccinate, in resurgences of diseases we had previously suppressed, such as whooping cough, and Rubella.
the vast majority of opposition to vaccinations is predicated on information that was fraudulently derived, and irresponsibly disseminated. I think that frustration with this misinformation is driving a large proportion of the intolerance that many medical professionals are demonstrating when people express their concerns, but I don't feel that that frustration gets us anywhere.
Our society places a high value on the principle of autonomy. And if you are an advocate of autonomy, it's important to realize that the option of choice should be exercised responsibly, and on the basis of the best information available. Fear and tenuous supposition are poor substitutes for ratiocination and primary source material.
So let's be excellent to one another. And don't eat shit you bought on ebay. Jesus Christ, guys.
Friday, October 21, 2011
It is one of my absolute favorite times of year. I love the (stipulation: rare) stunningly clear and distinctly scented autumn days, I love the sweaters, I love the flavors of fall – the pumpkin, the sage, the maple syrup, the late blackberries. I love the way, even in the miserable, soggy, grim expanse of the pacific northwest, that subtle blush of color spreads over the leaves until all the trees blaze out in a defiance of crimson.
And I love the fall fashions. I get excited every year to see what new trends emerge. This year, there doesn’t seem to be much novelty in vogue, which has been really, really disappointing. Much like last year, we are still seeing a preponderant focus on ADD, ADHD, Asperger's, and bitching about the flu shot.
Oh heavens, I’m sorry. Did you think I was about to talk about clothing? If you want my sartorial critiques you are just going to have to wait until spring, when I’m good and donked up on vino verde and someone gives the Olsen twins another slab of stock in Walmart. Until then, I’m going to stick to sarcasm directed towards issues more directly in my wheelhouse, though admittedly those issues are pretty much confined to “bottles of wine that cost less than 10$.” But it’s my favorite season, google keeps sending maniacs to this blog, some people just had shoulder surgery, and anyway I’m hoping to post a little more frequently this term, as It has become far more imperative that I avoid any actual work. There’s also the small matter of needing to step up my game after I accidently promised to marry everyone I meet on the internet. I’m inspired!
So God damn, could we just move on to something innovative in our disease crazes? For years, we have been over-diagnosing and carping about the same old shit. Remember when suddenly everyone had depression? And now everyone has ADD? For god’s sake, everyone had Attention Deficit Disorder when I was a kid, and it’s been completely played out for years. For awhile, I really thought that the grand obsession with the Autism spectrum was going to help guide our focus in a new and truly avant-garde direction. But, no. Alas. I don’t exactly know who decides these things, but please just get a grip. It is way past time to move on. These guys are sticking like denim when they should have been jeggings. Let’s be real.
Every year holds the promise of a new arena of pathology, and every year I’m held back by a redundant deluge of the several million examples of why we should probably declare Jenny McCarthy’s asinine twitter feed a public health emergency. This year, I was so sure that things were going to be different. Firstly, we sequenced the BLACK PLAGUE. THE BLACK FUCKING PLAGUE, Y’ALL. And then we found out that the black plague AINT SHIT! How Badass is that?! Like, if the black plague were to come back, our immune systems wouldn’t even give a fuck! Our immune systems would give the black plague the kind of scornful once over that gets directed towards a fat girl who wore the same dress as you to a party. “Oh,” our immune systems would say. “I didn’t know you were coming.” As an aside, our immune systems would turn to our nervous system and whisper something about how they just let anyone in, these days. Daaaaaaaamn.
Secondly, popular culture has given a big boost to those of us in the health services by making epidemiology really, really sexy.
Remember how lame Dustin Hoffman was in Outbreak? 2011 won’t stand for that! The bathrooms in movie theaters after Contagion lets out are filled with people washing their hands more thoroughly and self consciously than ever before.
I realize that it’s really difficult to establish a cultural trend of conditions that are at baseline binary – I mean, you either have tuberculosis or you don’t. But there are so, so, so many disorders that fall somewhere on a diagnostic spectrum; couldn’t we just give one or two of those a chance to get crammed all the hell the way down the throats of people until we’re so goddamn sick of them we could just die? Like Trichotillomania, or Histrionic personality disorder, or Anemia? Obsessive Compulsive Disorder looked to be making a comeback, but much like overalls, that movement fizzled out in a hiss of Jack Nicholson. I think we’re doing a massive disservice to a huge component of the population by failing to acknowledge that pestilence, plague, and the vast and colorful spectrum of viral and bacterial infections are relevant and often integral parts of many lives. Maybe we could start a movement encouraging increased sensitivity? Who exactly decided that whole populations are suffering from a disadvantage as opposed to an alternative lifestyle? I’ll be the first to acknowledge that I don’t always remember to refer to some individuals as “differently-eased.”
I know that some of you will be skeptical. “What’s next?” You’ll ask. I’ll probably ignore you. Considering that the slippery slope argument inevitably ends in the mass extinction of a vulnerable population or sex with dogs, I try to use it sparingly if at all. I can only take so much.
On that note, Let’s talk about pathology as a pastime.
The Mütter museum in Philadelphia is a warped wonderland of deformity and bizarre affliction.
A monument to morbidity, the museum is in fact beautiful, gleaming mahogany and burnished wood cases housing row upon row of grinning, alarmingly imperfect skulls behind spotless glass.
In a concession to modern sensibilities, there is a half assed exhibit at the very beginning of the museum dedicated to medical forensics, civil war wounds, and forensic anthropology.
The museum itself is a part of the Philadelphia College of Physicians, which, founded in 1787 boasts the oldest doctors in America. (Some details fuzzy.) The museum metastasized from a collection of curiosities donated by Dr. Thomas Mütter in 1858, and quickly became a repository for all the screwed up things people secretly want to look at but need some thinly veiled educational veneer as an excuse.
That sign says, “I kept this monster hand in a jar so that next century, all you little bitches who can buy hand sanitizer in the express line at Old Navy and know how to defecate remotely can wrap your sterile little minds around what Gangrene looked like.”
One of my favorite exhibits was this exquisitely articulated skeleton. The bones are twisted and feathery, the joints eroded by strain and friction. As a piece of art, it’s breathtaking. As a monument to the freakish potential for human suffering, it’s heartbreaking.
This exhibit below was way more fun, because it is the direct result of the fascinating and limitless extent of human imbecility.
There are 32 drawers in this cabinet, and each one of them is filled completely with the staggering array of fatuous things that people have somehow choked to death on. All the usual suspects, like buttons, small bones, marbles, sanctimony and excessive cologne are all represented, but some of this shit is insane. Why would you put fishing lures in your mouth? Why? WHY????! I can only conclude that there are numerous people who have just got the concept of fishing completely ass backwards in the most pathetic and tragic way possible.
One of the specialties of the museum is abnormal births, and there is an entire wall dedicated to portraits and biographies of Siamese twins, jars of conjoined fetuses, and in one central isolated case, the embalmed body of conjoined brothers who lived into old age, acquiring separate farms, and wives, and lives that they took turns living weekly.
The museum may seem grotesque, exploitative, morbid, deranged. But the subjects are preserved lovingly, displayed with respect and deference, and painstakingly cared for.
While it’s true that I was fascinated by some, and repelled by others, and while it’s clear that the point of the museum is to cater to that slightly unhinged, gruesome obsession we have cultivated with the alien and the dead, there’s something to be said for how humbling it feels to stand in front of the skeleton of a ten foot tall woman, and wonder what your life would be like if you were defined by an aberration so extreme you could never hope for an interaction that was not somehow colored by it.
And there’s something to be said for the kind of miraculous transformation that can bring us face to face with the freaks and the feared, the sideshow mutants and the tragic remains of lives lived in pain, and somehow endow the encounter with dignity and intimacy, and leave us with the suspicion that just beyond some numinous boundary, the things we deny are reverently illuminated and monstrously sacred with the strangest beauty.
Thursday, October 6, 2011
It’s been a long few months. As much as I am enjoying graduate school, I have to admit that being obliged to prioritize all my activities has really forced me to acknowledge just how much I enjoy drinking. Boy oh Boy. Then again, people talk a lot about the benefits of recognizing and being mindful of your coping mechanisms, and since I don’t have health insurance I’m pretty positive that even if I really stepped it up and starting drinking at ten in the morning it would still be cheaper than therapy. Probably. Even assuming I only have about ten or fifteen therapy sessions a week, I would still come out on top. And this way, I can have therapy any time. WHO COULD JUDGE ME FOR THAT?!
I currently require more medicinal alcohol than usual, given the time of year and the uproarious run of luck I’ve been having lately. Some people get really excited for sweater weather. I get really apprehensive about spider weather. The Pacific Northwest is home to some incredible fauna, such as conifers, seasonal depression, and arachnids. Given the concatenation of various factors of my life, such as the fact that my house is a moribund wreck on par with Miss Havisham, the fact that there is obviously a curse on me, and the clemency of breeding conditions for ghastly pestiferous eight legged fiends, this has been a banner year for horrifying shit occupying my house. Even allowing that every year yields a prodigious crop of things that I completely fucking hate, this year has been particularly fruitful thanks to the nest of bragilions of what appear to be actual BLACK WIDOW SPIDERS LIVING IN MY DRYER. Although this is statistically unlikely, it is also not improbable given that my life is generally punctuated by the type of bad luck that is both contingently remote and generally inexplicable.
The consequences of this pyrrhic discovery are diverse. I live in fear, I am applying for a permit to carry a bazooka, and laundry is hella old school. Until an exterminator comes, our house is covered in layers of undergarments I washed in the bathroom sink. As usual, the environment around me is undergoing the inexorable transformation into that of a whorehouse.
As a more relevant repercussion, however, I have become excruciatingly aware of the inadequacy of my health insurance. Granted, a perfect plan for me would cover burns, inadvertent poisonings, spider bites, ethanol IVs, ancient curses, things I accidentally swallowed, motorcycle crashes and dysentery, which I hear from my HR representative is unlikely. But health care, and what constitutes adequate insurance for health care, are hot topics in the current landscape of U.S. legislation.
The general underlying premise of health insurance in various nations is predicated on what, in terms of U.S. constitutional law, is considered a right. Certain nations consider health insurance to be an unalienable right, whereas some philosophies regard it as a privilege. Regardless of your own personal opinions on the subject, it’s pretty clear that these diverse ideologies give rise to equally diverse systems of care.
Chinese medicine is more of a holistic process than the mostly reactive, specialized event type of care common in the US. Some aspects of Chinese medicine are completely accessible, intelligible, and evidently effective. Some are alarming, confusing, and inexplicable. And some processes are simply ineffable. A lot of the obstacles Western individuals encounter when attempting to parse Chinese medicine are direct results of ideological conflicts between Eastern and Western philosophies.
Health care in the United States is primarily evidence based, responsive, sterile, and specific. We manifest a constellation of symptoms, we remark those symptoms, we submit them to an accredited expert, and that expert in turn analyzes those symptoms and pronounces a diagnosis, which then informs a prescribed course of treatment predominantly contingent on the disease rather than the individual. Western medicine applies a highly specified and specialized approach to illness; conditions belong to specific parts of the individual’s body, and have distinct definitions and parameters.
The Chinese approach to medicine is entirely different; the individual is viewed as a system, each aspect is interrelated and dependent on the others. We as westerners have some difficulty envisioning the concept of a life force, a motive, fluid, dynamic and animate power within the body and the mind that flows both perceptibly and inexorably.
Also, putting a snake in a bottle and covering it with booze is not necessarily consonant with my idea of tylenol.
My field being medical ethics, and having a personal investment in the scientific method, there was pretty much no way I could visit a country with such a markedly different epistemology without participating in some hands on research. The following activities are things we engaged in in the interest of exploring alternative ideologies.
(Note: As the Principle Investigator, I was able to outsource some of the more tedious data collection, and focus on diligently documenting the procedures and adhering to the protocol. Being a PI means that you don’t have to do any boring shit like math or work. You get a graduate student to do that kind of BS.)
This treatment requires that fire is used to suck the air out of a glass globe, which is then immediately affixed to your skin by way of advanced super heated vacuum technology. Ever cleaning the globe is unacceptable.
EEEEEEEEEK. Tedious Data Collection like being IMMOLATED.
Bamboo cups are added to make you look less like a pokemon. The difference between the two vessels, and the rationale for the disparate application, was not explained to me in a way that I could comprehend. This could be because it doesn’t make any sense, or because my Chinese is so overwhelmingly Bu Hao.
The final product, is, however, inspiring.
My experience with Chinese medicine had heretofore been exposure to repellent substances that are alleged to improve virility. There is traboccant evidence to prove that the worse a thing is, the better it will be for your manhood. Rat juice? Horse Anus? Essence of Cloaca? These are not Ozzy Osbourne solo projects. These are treatments. It might also be germane to note here that every other experience I have had with Chinese medicine has been the procedure where a person repeatedly strikes your wrist with their eyes closed and then tells you that you’re fat. This should be experienced annually.
So imagine my excitement when our friend Shao Shao offered us the opportunity to consult with a traditional Chinese Medical Doctor in his home clinic. I don’t know what you picture when you hear the term “home clinic” (For me, it’s reminiscent of the bathroom cut scenes in Silent Hill, but you may have had a better childhood), but the reality in this case comprehended a single room with a corroded floor, flyblown mirror, and a peeling decal of a long washed up Chinese pop star on the wall. At least it wasn’t a home surgical suite.
The room was about 20 square feet, and was crowded and damp. In addition to myself, my brother, Shao Shao and the doctor, the room contained a camp bed in déshabillé, a rusted rotary fan, two ancient computers, and several posters of the human body of the type usually seen on the wall at budget massage parlors. (as an aside, unlike Vietnam, massage parlors in China are not generally used as euphemistic fronts for whorehouses. Those are hair salons, as Chinese humor is geared towards the growing body of 12 year olds that think a double entendre involving the word “head” is hilarious.) Drying lines of faded clothes and greying underwear were roped across the ceiling.
The doctor himself was wearing an outfit that presumably conformed to the standard professional uniform. A hastily donned frayed white shirt, paired with worn professional grade underpants. “BAD BOY!” proclaim the ragged boxers. “USA!”
After the introductions, the exam began. Fred admitted to feeling tired and stressed out. The doctor asked about his diet, his exercise, his love life. He prodded Fred in various places, and listened to his chest.
Towards the end of the exam, the doctor repeatedly tapped Fred’s wrist and then informed him that he was fat. Thank God, because I was beginning to feel a little self conscious and uncomfortable. “Should I say something?” I thought. “I’m certain this man is really breaching the standard of care by omitting this procedure.” We were looking at a serious malpractice suit here. What a relief!
Ultimately, the doctor gave Fred a plastic pouch of his personal formula of all purpose panacea, which he kept in a grungy plastic bag underneath his camp bed.
The storage instructions in Chinese translate roughly to: “Keep in a gross dark place. Film with grime. Refrigerate after opening.”
The efficacy of this treatment is currently under evaluation.
In many ways, I enjoyed my experiences with Medical treatment in China far more than I have in the states. I find a lot of comfort in massage. I feel like western medicine has a lot to learn from acupuncturists. I firmly believe that the US could benefit from the Chinese practice of providing pedicures with 90 minute foot rubs for less than twenty dollars. But more than anything, I really enjoyed the novelty of being treated as more than the sum of my parts.
Although my experiences with the Gynecologist were really unsettling.
Wednesday, April 27, 2011
We trekked across the flatlands to join an academic conference in Xilinhot attended by several of Fred's classmates. Xilinhot is famous for giving a shit about Genghis Khan, by which I mean that Xilinhot is pretty much the cultural equivalent of the bar attached to a Super 8 motel somewhere in North Dakota on a Tuesday night. They have a cultural history museum, the top floor of which is dedicated to paper mache reproductions of the Tyrannosaurus Rex. They have a national gynecology hospital, flamboyant, evocative and nauseating in festive pinks and purples. What they do not have is a hotel willing to board foreigners or a restaurant that doesn't evoke the subconscious self loathing of a first date at a bowling alley.
Fred and I dragged our bags in and out of several reeking taxis, trudging from hotel to hotel. One woman screamed when she saw us. Another one called the police.
This turned out to be awesome, since the police decided it was part of their civic duty to find us a hotel. They placed us in the back of their police car and drove us down the seediest, most pathetic street that ever wended its useless way to a hole that would rent a room to white people.
The hotel was hidden behind a high facade, festooned with topless men lounging gracelessly on the grimy bricks, T shirts tied around their slick foreheads, beer bottles sweating rivulets in the merciless heat. Women dangled ugly babies and stared vacantly as the police cruiser scraped its way up the uneven drive. At night, a motley and swashbuckling pride of indolent taxi drivers lurked around the hood of an idling Buick, smoking harsh cigarettes and squinting into the broken street.
One of the benefits of finding yourself in an area with limited tourist appeal is that there are fewer aggressive individuals with insinuating smiles that are willing to take you to see something for a "cheap price." One of the drawbacks is that there are still plenty of people willing to take you to see nothing for a whole lot.
So when a jovial, portly, middle aged cab driver offered to give us a tour of the terrain surrounding the city, including the places his parents took him as a child, we were mildly skeptical. "We don't get many foreign visitors here!" He exclaimed, rubbing his shiny forehead with an honest to god handkerchief. "I think it is our duty as citizens to show our visitors our country." Fred was for it because inner Mongolia is as boring as watching a cow starve. I agreed because my intuition is more likely to endorse an individual if he looks like Mr. Pickwick, regardless of ethnicity. D. agreed to come back for us after lunch, and told us he would charge us about 15 US dollars.
The first leg of the drive was beautiful, in a barren sort of way. D drove along the back roads so we could watch lanky, ochre colored boys drive spindly, wild horses across the plains.
The parched ground was cracked, and nearly smoking in the noon sun. D. drove slowly, stopping every time I pointed my camera out the window. With the day at its hottest, we pulled the cab into an uneven gravel lot overlooking a wide swath of grassland. We ducked under the blistering arm of a wrought iron gate and hiked up the asphalt path until it ended. The plane was endless, and the rocky outcrops broke the smooth face irregularly, providing slivers of inadequate shade, jutting incongruously and impotently out of the landscape. Below us, blinding in the direct light of the summer sun, stretched the reservoir, the surface glassy and brilliant, crystalline and inviting.
D. led us down a rocky path to the edge of the water, until the stones gave way to a thick, silky mud that coated our feet and left silicate grit between our toes. The water was extraordinary - cool and still, with silvery fish appearing and disappearing rapidly around our ankles. D. waded in up to his waist, and grinned at us. "I never learned to swim," he explained sheepishly. "This is the only water around."
Climbing back onto the rocky shore, we were greeted by a horde of obnoxious teenagers with cell phone cameras taking our picture. "Lao Wai!" They informed each other, pointing. "Lao Wai!" We affirmed. It was like first contact without the spaceship. I encourage you to go to China with a horde of other white people, and simply repeat everything that people say while they take your picture. If you really want to have some fun,
"dai4 wo3 qu4 kan4 ni3de ling2dao3"
means "Take me to your leader," and I suggest that you throw that in once or twice, just to up the ante a little. Trust me. It will be hilarious.
Tourism in China is essentially a carnival of shit that is ridiculously old, where you are hustled from one busted thing to the next and people attempt to sell you absurdly overpriced shirts that depict the busted thing you just saw. For years, tourists have gone to China and paid money to look at old busted shit, which is why, when you go to China, people are really enthusiastic about charging you money to see shit that is old and busted. China is really capitalizing on the two pronged theory that 1) things that are "Ancient and Beautiful" are attractive to populations who continually recycle styles from 20 years ago like there is ANY amount of time that might make stirrup pants acceptable again, and 2) that those same populations with the fashion memories of goldfish are by extension unable to distinguish between a pile of rubble from a defunct noodle stand and some palatial ruins from the Ming dynasty. And who can blame them. We are the assholes acting like jeggings are reasonable. Just be thankful that the T-shirt you bought says you saw the great wall, even if it was "Ping’s discount hovel of pajamas." You know in your heart that it doesn't matter to you.
We hesitated. We were in the middle of nowhere, with little money, in sandals and swimsuits, with no other viable mode of transport, no one to call, and no reasonable alternatives. We looked at each other. We shrugged. We agreed reluctantly, and got in the car. We pulled out of the gravel lot, and rejoined the long dark highway snaking across the grasslands. five or ten minutes passed before we again pulled off the highway. D. shut off the engine. "Just a moment," he said to us.
If you are now, like we were then, reading this post waiting for the moment that our seemingly philanthropic guide dropped his mask and stood revealed to us in his true colors, you need to read no further. It was at this juncture that this man's character was exposed in all of its nakedness, burning like a brand in the vast expanse of the dry plains. He left the driver's seat, and moved around to the truck of the car. As soon as he was out of the car, I turned to Fred. "What is going on?!" I asked. We had no idea. Was this the moment he would demand additional payment for his unsolicited tour? Were we going to have to battle it out along the side of a desolate highway in the middle of god knows where in inappropriate walking shoes and damp clothing? Did he realize how threatening the eternal, unbroken plains appeared in the context of our potential disagreement? Would he abandon us? Rob us? Sell us? Would the bland, calcified fields surrounding us soon house the drying HUSKS OF OUR DESICCATED CORPSES? WOULD I BE MUMMIFIED IN FRIGGING MONGOLIA OVER A FIFTEEN DOLLAR TRIP TO VIEW AN ENORMOUS PLASTIC REPRODUCTION OF GHENGIS KHAN'S FAKE HEAD?
We waited anxiously, listening to the thumps and rustles coming from behind us as D. rummaged through the trunk of the cab. For shovels? Shackles? Firearms? Worse?
The sun was getting lower as D. opened the door and clambered back into the driver's seat, clutching a large sack. His ruddy face was filmed with sweat, and creased into a habitual congenial grin. Under the circumstances, his good natured smile seemed sinister, lochetic, foreboding. Nodding briefly and apologetically to me, he turned to Fred and spoke rapidly in Chinese.
Beaming, he produced two large water bottles from the bag, slick with glistening condensation, kept cold in a cooler in the trunk. Fred translated. "He thought we might be hungry, and he saw on a television special once that white people like to eat bread, so he went to the store. He wasn't sure what kind of bread white people like, though, so he bought us a couple kinds. He said they were out of coca cola, and they only had pepsi, so he got us water. He hopes that's ok. He knows Americans really like coca cola."
Although in a sense anti-climactic, the soft yellow loaf filled with dates and jam was delicious, the water welcome to throats as parched as the steppe. Our guide drove faster through the growing twilight, explaining that if we could mount the next hill quickly, we could watch the sun set over the bright silver rivers leading into the reservoir.
At the summit, we pulled the cab off into the bushes and turned to watch the deepening crimson rays glance brilliantly from the surface of the winding tributaries, and transform the dales into pools of gold and shadow. In the last dying light, a collapsing cottage caught the final beams and blazed into an unexpected beauty, radiant in its liquefaction, in the syrupy golden of the thickening dusk. Never had some old busted shit seemed so compelling in its desuetude; the steppe looked so homogenous in the broad day, but the growing penumbra highlighted the hills and dips. The light on the uneven plain fell in viscous chunks, collecting in dales and running slowly down the hillsides.
Then we turned our steps towards the head of Genghis Khan.
As it turns out, the head is better positioned to view from a distance than it is placed for tenable approach. In our plastic sandals, we climbed over barbed wire fences and the ruins of old cattle pens. Nettles brushed our legs, huge crickets exploded from the brush up into our faces, whirring and clicking like mechanized irritants. Outlined in the dusk, the silhouette was a prepossessing figure from the road. Up close, it was clear even in the advancing night that the paint was flaking, the plastic scraped and worn.
Bushwhacking our way back to the car in the dark, our guide remarked, “maybe we weren’t supposed to climb these fences.”
The freeway was dark, indistinguishable from the rest of our surroundings. No lamps lit the roadway, and there were few cars or trucks shining their headlamps through the summer night. We drove through the night in silence, occasionally irradiated by the headlamps of oncoming cars. Our guide’s face was thoughtful. The steppe was crossed with shadows in the moonlight.
When he broke the silence, his voice was hesitant, and quiet. Music was an important part of Mongolian culture and communication, he told us. Since we had asked so many questions about inner Mongolia, and about the people, he wondered if we would like to hear some traditional Mongolian songs?
His voice was surprisingly beautiful, pitched high and clear, with a deep expression and wide range. In the deepening night, with the dim luminance of the moon and the dashboard lights, the sound was mesmeric, soothing, compelling.
In the silence after the song, I felt the rising melancholy of homesickness, coupled with the strange sensation of being precisely where I belonged.
As we re-entered the city, D. received a phone call from his wife. He spoke with her for a few minutes, and then asked us if we had enough time to see some famous temples in the city. His wife had admonished him. “Who wants to see a hole filled with water? You should have taken them to the monastery!” As you may have divined, the temples had all been destroyed during the cultural revolution, but had been rebuilt to the exact specifications of a new thing that looks just as busted as it would look were it actually to have decayed over millennia.
His entire family was waiting there to welcome us.
D. looked anxiously over his glasses at us. His son, who had inherited the squat frame of his father, was uninterested in school. His grades were not good, and he insisted he wanted to be a famous basketball player. Maybe we could talk to him? If he were to meet some foreigners, perhaps he would become more interested in learning English?
His wife escorted us all over the temple. The night was clear and warm, and the public square was crowded with people. We posed for several pictures with the family, and talked with the son, and coaxed the daughter, who was terrified of us.
As it grew later, the family drove us home in the cab. They refused to accept any payment beyond the fifteen dollars we had paid earlier in the day, which would barely cover our host’s rent to the cab company, let alone the gas. “Maybe someday,” D. said wistfully, “If I can ever visit America, someone will show me their city, too.”
Good luck, pal.
It beggars belief that out there in the world there are more than a scant handful of people who would, with a family to feed, abdicate an entire afternoon of income to spend eight hours showing two strangers the sentimental landmarks of their dreamy childhood; who would turn a stale, contrived burlesque of a temple into a warm, joyful family outing; who would volunteer the depth and breadth of their memories, experiences and tradition in the service of promoting education and understanding; who would modify their curiosity with a superhuman exertion of tact; who would, in light of a broken radio, sing the haunting lullabies of their babyhood in the weak light of an aging cab, a single speeding pool of light on a long, dark, unbroken road.
And please recall that he was out of pocket for several kinds of bread.
So if you ever come across this gentleman, out there in the world, marshal whatever forces you have at your disposal to conquer any baseness or selfishness or impatience in your nature. Set aside your daily concerns, defer some pressing obligations, and spend one afternoon treating a stranger to a personal guided tour of a place you grew up loving. Do it for me. Do it for Karma. Do it in the spirit of building international relations. Or just do it because nothing can approach the experience of encountering, in a howling wilderness, the lesson that ordinary people can have the extraordinary effect of becoming the kindest person you have ever met.